Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

  • Lee, Ji Seong (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Chee, Hyun Keun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Kim, Jun Seok (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Song, Myong Gun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Park, Jae Bum (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Shin, Je Kyoun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine)
  • Received : 2014.09.16
  • Accepted : 2014.11.07
  • Published : 2015.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, $47.7{\pm}9.7years$; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was $13.5{\pm}7years$. The mean preoperative Wilkins score was $9.4{\pm}2.6$. Results: The mean mitral valve area obtained using planimetry increased from $1.16{\pm}0.16cm^2$ to $1.62{\pm}0.34cm^2$ (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from $202.4{\pm}58.6ms$ to $152{\pm}50.2ms$ (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from $9.4{\pm}4.0mmHg$ to $5.8{\pm}1.5mmHg$ (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period ($39{\pm}16months$). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

Keywords

References

  1. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 1984; 87:394-402.
  2. Iung B, Cormier B, Ducimetiere P, et al. Functional results 5 years after successful percutaneous mitral commissurotomy in a series of 528 patients and analysis of predictive factors. J Am Coll Cardiol 1996;27:407-14.
  3. Desideri A, Vanderperren O, Serra A, et al. Long-term (9 to 33 months) echocardiographic follow-up after successful percutaneous mitral commissurotomy. Am J Cardiol 1992;69:1602-6. https://doi.org/10.1016/0002-9149(92)90711-7
  4. Bouleti C, Iung B, Himbert D, et al. Reinterventions after percutaneous mitral commissurotomy during long-term follow- up, up to 20 years: the role of repeat percutaneous mitral commissurotomy. Eur Heart J 2013;34:1923-30. https://doi.org/10.1093/eurheartj/eht097
  5. Bouleti C, Iung B, Himbert D, et al. Long-term efficacy of percutaneous mitral commissurotomy for restenosis after previous mitral commissurotomy. Heart 2013;99:1336-41. https://doi.org/10.1136/heartjnl-2013-303944
  6. Song JK, Kim MJ, Yun SC, et al. Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery. J Thorac Cardiovasc Surg 2010;139:103-10. https://doi.org/10.1016/j.jtcvs.2009.04.022
  7. Kim JB, Ha JW, Kim JS, et al. Comparison of long-term outcome after mitral valve replacement or repeated balloon mitral valvotomy in patients with restenosis after previous balloon valvotomy. Am J Cardiol 2007;99:1571-4. https://doi.org/10.1016/j.amjcard.2006.12.088
  8. Yau TM, El-Ghoneimi YA, Armstrong S, Ivanov J, David TE. Mitral valve repair and replacement for rheumatic disease. J Thorac Cardiovasc Surg 2000;119:53-60. https://doi.org/10.1016/S0022-5223(00)70217-0
  9. Choudhary SK, Talwar S, Dubey B, Chopra A, Saxena A, Kumar AS. Mitral valve repair in a predominantly rheumatic population: long-term results. Tex Heart Inst J 2001;28:8-15.
  10. El Oumeiri B, Boodhwani M, Glineur D, et al. Extending the scope of mitral valve repair in rheumatic disease. Ann Thorac Surg 2009;87:1735-40. https://doi.org/10.1016/j.athoracsur.2009.03.009
  11. Omeroglu SN, Kirali K, Mansuroglu D, et al. Is posterior leaflet extension and associated commissurotomy effective in rheumatic mitral valve disease?: long-term outcome. Tex Heart Inst J 2004;31:240-5.
  12. Bakir I, Onan B, Onan IS, Gul M, Uslu N. Is rheumatic mitral valve repair still a feasible alternative?: indications, technique, and results. Tex Heart Inst J 2013;40:163-9.
  13. Chan PG, Hayanga AJ, Badhwar V. Repair of rheumatic mitral stenosis with bicommissural release, anterior leaflet augmentation and oversized annuloplasty. Multimed Man Cardiothorac Surg 2014;2014:mmt020. https://doi.org/10.1093/mmcts/mmt020
  14. Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg 2010;37:1039-46. https://doi.org/10.1016/j.ejcts.2009.11.019
  15. Salem DN, Stein PD, Al-Ahmad A, et al. Antithrombotic therapy in valvular heart disease: native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):457S-482S. https://doi.org/10.1378/chest.126.3_suppl.457S
  16. DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg 2010;139:76-83. https://doi.org/10.1016/j.jtcvs.2009.08.058
  17. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82:819-26. https://doi.org/10.1016/j.athoracsur.2006.03.091
  18. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation: a multivariate analysis. Circulation 1995;91:1022-8. https://doi.org/10.1161/01.CIR.91.4.1022
  19. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-43. https://doi.org/10.1016/S0022-5223(98)00450-4
  20. Duran CM, Gometza B, Saad E. Valve repair in rheumatic mitral disease: an unsolved problem. J Card Surg 1994;9(2 Suppl):282-5. https://doi.org/10.1111/j.1540-8191.1994.tb00942.x

Cited by

  1. Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country vol.27, pp.11, 2019, https://doi.org/10.1007/s12471-019-01315-x